右美托咪定对髋关节置换术后老年患者认知功能障碍的影响  

Effect of dexmedetomidine on postoperative cognitive dysfunction undergoning hip replacement in old patients

作　　者：郑国龙[1] 安礼俊[1] 苏珍[1] 刘艳[1] 刘海林[1] 

机构地区：[1]南京医科大学附属淮安一院麻醉科,江苏淮安223300

出　　处：《徐州医学院学报》2014年第10期638-640,共3页Acta Academiae Medicinae Xuzhou

基　　金：淮安市科技支撑计划（HAS2013034）;南京医科大学科技发展基金重点项目（2012NJMU152）

摘　　要：目的评价右美托咪定对髋关节置换术后老年患者认知功能障碍的影响。方法择期行髋关节置换术的老年患者80例，年龄〉60岁，性别不限，体重50～75kg，ASA分级Ⅱ或Ⅲ级，采用随机数字表法分为2组（n=40）：对照组（C组）和右美托咪定组（Dex组）。2组麻醉诱导和维持方法相同。Dex组于麻醉诱导前经静脉输注右美托咪定，负荷量为0．8μg／kg，随后以0．5μg·kg^-1·h^-1的速率静脉输注至术毕，C组给予等容量生理盐水。于麻醉诱导前1天（T1）及术后1天（T2）、2天（T3）和3天（T4）记录患者简易精神状态量表（MMSE）评分，记录术后3天内术后认知功能障碍（POCD）的发生情况。结果与术前1天比较，C组术后1、2天时MMSE评分降低（P〈0．05）；与C组比较，Dex组术后1、2天时MMSE评分较高，POCD发生率较低（P〈0．05）。结论右美托咪定可降低髋关节置换术后老年患者认知功能障碍的发生率。Objective To investigate the effect of dexmedetomidine on postoperative cognitive dysfunction after hip replacement in old patients. Methods A total of 80 ASA physical status Ⅱ or Ⅲ patients, aged 〉 60 years, weighting 50 -75 kg, who were undergoing hip replacement, were randomly divided into 2 groups （n = 40 each） ： control group and dexmedetomidine group （Dex group）. Anerhesia was induced with midazolam, etomidate, fentani] and veeuronim. The patients were thracheal intubated and mechanically ventilated. Anesthesia was maintained with propofol, remifentanil and vecuronim. A loading close of dexmedetomidine 0.8 μg/kg was infused over 15 min after tracheal intubation, followed by dexmedetomidine infusion at 0. 5μg ·kg^-1·h^-1 until the end of operation in Dex group, while the equal volume of normal saline was infused in control group. Cognitive function was assessed by Mini - Mental State Examination （MMSE） at 1 day before operation （ T1 ） and 1 day （ T2 ）, 2 days （ T3 ） and 3 ddays （ T4 ） after operation. The development of postoperative cognitive dysfunction was recorded within 3 days after operation. Results Compared with 1 day before operation, MMSE scores at 1 day, 2 days after operation were significantly decreased （ P 〈 0.05 ） in control group. Compared with control group, MMSE scores at 1 day and 2 days after operation were significantly increased and incidence of postoperative cognitive dysfunction within 3 days after operation was decreased （ P 〈 0. 05） in Dex group. Conclusion Dexmedetomidine can decrease the development of postoperative cognitive dysfunction after hip replacement in old patients.

关 键 词：右美托咪定 髋关节置换术 认知功能障碍 老年患者 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]